Somatic and visceral nociceptive signals travel via different pathways to reach the spinal cord. Additionally, signals regulating visceral blood flow and gastrointestinal tract (GIT) motility travel via efferent sympathetic nerves. To offer optimal pain relief and increase GIT motility and blood flow, we should interfere with all these pathways. These include the afferent nerves that travel with the sympathetic trunks, the somatic fibers that innervate the abdominal wall and part of the parietal peritoneum, and the sympathetic efferent fibers. All somatic and visceral afferent neural and sympathetic efferent pathways are effectively blocked by appropriately placed segmental thoracic epidural blocks (TEBs), whereas well-placed truncal fascial plane blocks evidently do not consistently block the afferent visceral neural pathways nor the sympathetic efferent nerves. It is generally accepted that it would be beneficial to counter the effects of the stress response on the GIT, therefore most enhanced recovery after surgery protocols involve TEB. The TEB failure rate, however, can be high, enticing practitioners to resort to truncal fascial plane blocks. In this educational article, we discuss the differences between visceral and somatic pain, their management and the clinical implications of these differences.

Background: This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics.

In this Pro-Con commentary article, we discuss the controversial debate of whether to provide peripheral nerve blockade (PNB) to patients at risk of acute extremity compartment syndrome (ACS). Traditionally, most practitioners adopt the conservative approach and withhold regional anesthetics for fear of masking an ACS (Con). Recent case reports and new scientific theory, however, demonstrate that modified PNB can be safe and advantageous in these patients (Pro). This article elucidates the arguments based on a better understanding of relevant pathophysiology, neural pathways, personnel and institutional limitations, and PNB adaptations in these patients.

Inadvertent injection of autologous blood in both subdural and intrathecal spaces following EBP is extremely rare. Case reports describe SSH or SAH after attempted EBPs. This illustration depicts combined subdural and subarachnoid collection after EBP for post dural puncture headache (PDPH)(from a lumbar spinal drain), 6 days after 40 ml of autologous blood was injected in the “epidural space” at the same spinal level as the preceding spinal drain. The T1-weighted sagittal (Panel A) and axial (Panel B) MR image of the spine demonstrates a subdural collection of blood (white arrows) extending from T12-L1 to sacral level and subarachnoid collection of blood (asterisks) extending from L3-4 to the termination of the thecal sac at S2. Mild backache and neck stiffness is not uncommon after EBPs. Worsening back pain with radicular symptoms suggests blood in the subdural or subarachnoid spaces which can result in meningitis, arachnoiditis, lower extremity weakness and radiculopathy.